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November 20, 2023

Improper Payments Detailed By CMS CMS touts that improper payments were under 10% in traditional Medicare and in Medicaid, but it is nothing to be proud of. The traditional estimator of 10% for fraud, waste, and abuse (FWA) is a misnomer. Recent studies suggest that true FWA is perhaps 25% of all healthcare expenditures. In 2021, healthcare expenditures were $4.3 trillion. That means almost $1.1 trillion is true FWA. #fwa #medicare #medicaid Link to Article Providers Impacted As Well When Star Ratings Fall Good article describing how providers suffer too when Star ratings fall in Medicare Advantage. Many have entered into partial or global risk-sharing arrangements with health plans and share in bonus revenue. (May require subscription.) #medicareadvantage #providers #stars Link to Article New Speaker’s Healthcare Advisor Named New House Speaker Mike Johnson (R-LA) has named Drew Keyes, a former Republican Study Committee staffer, as his senior health policy advisor.

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November 17, 2023

Civil Rights Groups Issuing Report Cards On State Medicaid Redetermination Processes With a large proportion of the 10M Medicaid disenrollees cut from the program for procedural reasons, a group of civil rights entities are issuing report cards to states. The report cards seek to call out whether each state has done the necessary due diligence during unwinding to ensure those who remain eligible retain coverage. While states and the Centers for Medicare and Medicaid Services (CMS) are at some fault, Congress is really to blame for not passing legislation that allowed for a longer transition time. #medicaid #redterminations Link to Article FTC Moves To Stop Hospital Merger in California Kudos to the Federal Trade Commission (FTC) on taking action to stop the merger of two California hospitals. The Biden Administration, including the FTC, Justice and Health and Human Services, have been active in calling attention to the massive consolidation occurring

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